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Management of Infection > Lecture 17 - Sexually Transmitted Infections > Flashcards

Lecture 17 - Sexually Transmitted Infections Flashcards

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1
Q

What are the most common symptoms of an STI?

A 
no symptoms 
a genital rash
urethral discharge 
genital ulceration 
lymph node swelling in groin region 
raised core body temperature
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2
Q

What is the most prominent STI in the uk?

A

chlamydia

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3
Q

What are important drivers of STIs?

A

cognitive

behavioural

biological factors

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4
Q

Cognitive development affecting STI?

A

younger adults tend to have less life experience so have reduced reasoning or judgement capacity

they tend to be more concrete thinkers so focussed on immediate circumstances and have reduced ability to plan ahead

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5
Q

Behaviour that can affect chances of getting an STI?

A

less likely to use a condom

more likely to have multiple/overlapping partners

greater likelihood ob substance use

an older partner predisposes to a relationship power imbalance
(sexual negotiation is more difficult, increased risk of involuntary intercourse and unsafe sex)

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6
Q

Why are younger females more susceptible to STIs?

A

cervical ectopy

decreased local immunity in genital tract

a smaller introitus and/or lack of lubrication can lead to traumatic sex

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7
Q

Increased susceptibility of STI in males?

A

occurs in uncircumcised males regardless of age

phimosis (foreskin cannot retract over the head of the penis)

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8
Q

Sexual health inequalities?

A

disproportionately affects those experiencing poverty and social exclusion

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9
Q

Sexual health inequalities are most prevalent in?

A

asylum seekers and refugees

sex workers and clients

homeless and young people in care

men who have sex with men

some black and minority ethnic groups

young people

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10
Q

What is sensitivity?

A

the proportion of people with a disease who will have a positive result

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11
Q

What is specificity?

A

the proportion of people without the disease who will have a negative result

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12
Q

What is high sensitivity good for?

A

ruling out a disease if a person tests negative

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13
Q

What is high specificity good for?

A

ruling in a disease if a person tests positive

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14
Q

What is the positive predicted value?

A

the proportion of people with a positive result who actually have the disease

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15
Q

What is the negative predicted value?

A

the proportion of people with a negative test who do not have the disease

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16
Q

What is chlamydia trachomatis?

A

an obligate intracellular parasite

small gram negative bacilli with no peptidoglycan layer in cell wall

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17
Q

What are primarily associated with urogenital infections?

A

Serovars D-K

vertical transmission between mother and baby possible

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18
Q

What are associated with lymphogranulosum venereum?

A

Serovars L1, L2, L2a, L3

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19
Q

How does C trachomatis exist?

A

in two forms

elementary body (infective form)

reticulate body (non-infectious form)

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20
Q

Where do C trachomatis elementary bodies infect?

A

columnar epithelial cells

incubation period until symptoms is 1-3 weeks

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21
Q

What % of people with C trachomatis are asymptomatic?

A

50% of infected females

80% of infected males

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22
Q

What might infection with C trachomatis cause?

A

a mucopurulent cervicitis in females and urethritis in males

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23
Q

What can ascending infection with C trachomatic cause?

A

pelvic inflammatory disease (PID) in women

5-10% of PID women develop perihepatitis (Fitz-Hugh-Curtis syndrome)

epididymitis in men

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24
Q

What can untreated C trachomatis lead to in women?

A

10-40% will develop PID

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25
What are the symptoms of PID?
vaginal discharge | lower abdominal pain (dull, aching, crampy, bilateral and constant) worsened by motion, exercise or intercourse
26
What can PID cause?
increase in risk of infertility, ectopic pregnancy and chronic pelvic pain
27
What can untreated C trachomatis cause in men?
epididymitis which may result fertility or sterility prostatitis urethritis causing painful urination and possible kidney problems
28
Swabs taken for chlamydia diagnosis?
urethral swab, rectal swab, cervical swab, midstream urine
29
Tests for diagnosis of chlamydia?
McCoy, Hep 2 or HeLa cell lines treated with cycloheximide (50-85% sensitivity, 100% specificity) nucleic acid amplification test (85-95% sensitivity, 99-100% specificity)
30
Treatment for chlamydia patients?
prefer a single dose of treatment until 2018 was 1g single oral dose of azithromycin
31
Why have guidelines for treating chlamydia changed?
in response to mycoplasma genitalium co-infection (3-15% of cases) concomitant rectal infections in woman with urogenital infection, not related to anal intercourse
32
Treatment of uncomplicated urogenital infection?
doxycycline 100mg bd for 7 days (contraindicated in pregnancy) azithromycin 1g orally as a single dose, followed by 500mg once daily for two days
33
Alternative treatment options for urogenital infection?
erythromycin 500mg BD for 10-14 days ofloxacin 200mg BD (or 400mg OD) for 7 days (CI in pregnancy)
34
Treatment for LGV?
doxycycline 100mg BD for 21 days
35
What other advice for treatment of chlamydia?
abstain from all forms of sex during treatment contact tracing to minimise transmission
36
Why is doxycycline CI in pregnancy?
it has an ability to concentration in the bone structures in babies
37
Vaccine for chlamydia?
nasally adminstered vaccine has been developed using a novel fusion protein antigen that covers multiple chlamydia serovars
38
Administration of the chlamydia vaccine?
3 x IM followed by 2x instranasal boosters vaginal antibody responses - humoral immunity interferon gamma production - cell mediated immunity
39
What is neisseria gonorrhoeae?
a gram negative intracellular aerobic diplococcus
40
Female to male transmission of neisseria gonorrhoeae?
~20% per vaginal intercourse (60-80% after 4 exposures)
41
Most common presentation of neisseria gonorrhoeae in males?
mucopurulent urethritis >80% 50% dysuria
42
Male to female transmission of neisseria gonorrhoeae?
~50-70% after vaginal intercourse includes vaginal discharge <50%, dysuria (10%), dyspareunia and mild abdominal pain (<25%)
43
Rectal infections of neisseria gonorrhoeae?
~40% female (similar in MSM)
44
Pharyngeal infections of neisseria gonorrhoeae?
~15% oral sex - fellatio > cunnilngus
45
Incubation period of neisseria gonorrhoeae?
1-14 days
46
Primary diagnosis of neisseria gonorrhoeae?
by NAAT sensitivity >96%, specificity 99-100%
47
What else can be used to diagnose neisseria gonorrhoeae?
culture swabs for diagnosis and/or resistance profiling on Thayer-Martin plates sensitivity 90-95% for males and 50-75% for females, specificity 100%
48
Treatment of uncomplicated anogenital and pharyngeal infections of neisseria gonorrhoeae?
1g ceftriaxone IM as a single dose (if susceptibility unknown) 500mg ciprofloxacin as a single dose (if susceptibility known)
49
Advice for neisseria gonorrhoeae infection?
test of cure in all patients recommended abstain from all forms of sex for 7 days
50
Alternative regimes for neisseria gonorrhoeae?
cefixime 400mg orally as a single dose plus azithromycin 2g orally gentamicin 240mg IM as a single dose plus azithromycin 2g orally spectinomycin 2g IM as a single dose plus azithromycin 2g orally azithromycin 2g as a single oral dose
51
When is cefixime advisable?
if an IM injection is contraindicated or refused by the patient resistance to cefixime is low in the UK
52
When is spectinomycin not recommended?
for pharyngeal infection because of poor efficacy
53
Azithromycin use?
the clinical efficacy does not always correlate with in vitro susceptibility testing and resistance is high
54
What is anogenital warts (condyloma) caused by?
human papilloma virus (HPV) around 30 associated with anogenital infections
55
What are >90% of anogenital warts caused by?
HPV 6 & 11 these types have low oncogenicity
56
How is HPV spread?
by skin to skin contact (penetrate sex not a prerequisite) or indirect e.g. sex toys
57
Where is HPV present?
on genitals groin region anus
58
prevalence of HPV?
30-50% of the population
59
Transmission rates of anogenital warts?
Male to female 55% female to male 70% @ 3 months
60
Incubation period of HPV?
months to years
61
What vaccine is HPV included in?
the quadrivalent cervix vaccine gardicyl
62
Treatment of anogenital warts?
restricted to external visible warts
63
Treatment if <4cm skin surface involved?
podophyllotoxin
64
Treatment cycles of anogenital warts?
four treatment cycles consist of BD application for 3 days then followed by 4 days rest (highly irritave)
65
Response rate of treatment of anogenital warts?
30-70% response rate at 4-6 weeks but recurrence is common
66
What is used for refractory cases?
imiquimod 3x a week for up to 16 weeks recurrence is less common
67
What does imiquimod do?
stimulates the immune system to increase uptake of interferine alpha 2 which has potent antiviral activities
68
Treatment for large surface areas?
cryotherapy or electrocautery to the skin area cryotherapy is preferred as it has a lower tendency to leave any scarring
69
What causes anogenital herpes?
HSV 1 or 2
70
Transmission of HSV?
skin to skin contact (penetrative sex not required) or indirect e.g. sex toys
71
What % of people infected with HSV will have mild/no symptoms?
80%
72
What % of the population have HSV 1?
50% by age 30
73
What % of the population have HSV 2?
3-10% (up to 25% of sexually active persons)
74
Incubation period of HSV?
4-14 days or even longer
75
Characterisation of primary infection of HSV?
flu-like symptoms and small blisters that burst to leave red open sores (up to 20 days duration)
76
Where can these blisters affect?
genitals, rectum, cervix, buttocks or thighs urination can be painful
77
Diagnosis of HSV?
by sampling blister (PCR)
78
Treatment of HSV 1&2?
400mg aciclovir for 5 days
79
Recurrence of HSV1 ?
50% chance of at least one recurrence
80
Recurrence of HSV2?
80% chance of at least once recurrence
81
What diminishes with time of HSV?
frequency and severity

Management of Infection (36 decks)

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